title: Improving detection and notification of tuberculosis cases in students in Shaanxi province, China: an intervention study.
abstract: BACKGROUND
  Cooperation between different public and private health institutes involved in tuberculosis (TB) control has proven to enhance TB control in different settings. In China, such a mechanism has not been set up yet between Centers for Disease Control (CDCs) and university hospitals despite an increased TB incidence among students. This study aims to improve arrival of TB suspects identified by universities at the CDCs in order to manage them under standardized, directly observed treatment-short course (DOTS) conditions according to the National Tuberculosis Programme (NTP) guidelines.
  
  
  METHODS
  Five matched pairs of universities were randomly assigned to the control and intervention group. After a baseline survey, a cooperation mechanism between local CDCs and university hospitals was set up in the intervention group. The effects on referral of TB suspects to the local CDC, tracing by the local CDC, and arrival at the local CDCs were assessed. Differences were tested by means of the chi-square test.
  
  
  RESULTS
  During the baseline survey, the referral, tracing and arrival rates were between 37% and 46%. After implementation of the cooperation mechanism, these rates had not changed in the control group but increased significantly in the intervention group: the referral, tracing and arrival rates were 97%, 95%, and 93%, respectively.
  
  
  CONCLUSIONS
  It is feasible and effective to set up cooperation between CDCs and university hospitals to increase the number of TB suspects examined by CDCs and increase the number of TB patients treated under DOTS conditions. These public-public mix (PPM) activities should be expanded to cover all other university hospitals in China.
authors.affiliation: Shaanxi Provincial Institute for TB Control and Prevention, Xi'an, Shaanxi province, PR China. zhthfzhk@126.com
authors.forename: Tianhua
authors.initials: T
authors.lastname: Zhang
authors.forename: Liujia
authors.initials: L
authors.lastname: Guo
authors.forename: Shaoru
authors.initials: S
authors.lastname: Zhang
authors.forename: Weiping
authors.initials: W
authors.lastname: Liu
authors.forename: Guanghua
authors.initials: G
authors.lastname: Chen
authors.forename: Ma
authors.initials: M
authors.lastname: Hui
authors.forename: Guangxue
authors.initials: G
authors.lastname: He
authors.forename: Marieke J
authors.initials: MJ
authors.lastname: van der Werf
authors.forename: Susan
authors.initials: S
authors.lastname: van den Hof
mesh_terms: D002681:China / Q000453:epidemiology; D016358:Contact Tracing; D023801:Directly Observed Therapy; D018563:Disease Notification / Q000592:standards*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007407:Interviews as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013334:Students; D014376:Tuberculosis / Q000175:diagnosis* / Q000453:epidemiology